Differential patterns of circulating adhesion molecules in children with bronchial asthma and acute bronchiolitis

The object of the study was to assess the levels of circulating forms of the cellular adhesion molecules ICAM-I, VCAM-1, E-selectin, L-selectin and P-selectin in young children with asthma and acute bronchiolitis. Thirty-nine children aged 12 to 84 months with mild or moderate asthma were studied at admission for acute asthma (n = 15) or in a stable phase (n = 24). Ten of the children with acute asthma were seen again after one month. Twenty-two children aged 1 to 17 months with acute bronchiolitis and nine non-atopic controls were also included in the study. In children with acute asthma, the mean concentration of circulating soluble ICAM-1 (SICAM-I) was increased compared to children with stable asthma (mean 442 μg/l versus 363 μg/l; p < 0.001) and to controls (363 μg/l; p < 0.05). The levels of SICAM-1 remained high at follow up. In children with stable asthma, the mean serum concentration of soluble L-selectin (sL-selectin) (2080 μg/l) was significantly higher than in the controls (1664 μg/l; p < 0.05). The levels of circulating cellular adhesion molecules were similar in atopic and non-atopic asthmatics. Children with acute bronchiolitis had increased serum levels of soluble VCAM-1 (sVCAM-I) (1637 μg/l versus 1019 μg/l in the controls; p < 0.01) and sL-selectin (2041 μg/l versus 1664 μg/l in the controls; p < 0.05). There was no difference between the levels of circulating cellular adhesion molecules in children with respiratory syncytial virus (RSV) positive and RSV negative bronchiolitis. Soluble E-selectin (sE-se-lectin) and soluble P-selectin (sP-selectin) in serum were not significantly increased in any of the groups studied. In conclusion, our data suggest differential patterns of circulating cellular adhesion molecules in young children with acute asthma, stable asthma, and acute bronchiolitis, which may reflect differences in the underlying inflammatory processes in these obstructive pulmonary diseases.     

Acute facial nerve palsy in children: how often is it lyme borreliosis?

Acute facial nerve palsy in children may be caused by infection by Borrelia burgdorferi, but the incidence of facial nerve palsy and the proportion of facial nerve palsy caused by Lyme borreliosis may vary considerably between areas. Furthermore, it is not well known how often facial nerve palsy caused by Lyme borreliosis is associated with meningitis. In this population-based study, children admitted for acute facial nerve palsy to Stavanger University Hospital during 9 y from 1996 to 2004 were investigated by a standard protocol including a lumbar puncture. A total of 115 children with facial nerve palsy were included, giving an annual incidence of 21 per 100,000 children. 75 (65%) of these were diagnosed as Lyme borreliosis, with all cases occurring from May to November. Lymphocytic meningitis was present in all but 1 of the children with facial nerve palsy caused by Lyme borreliosis where a lumbar puncture was performed (n = 73). In this endemic area for Borrelia burgdorferi, acute facial nerve palsy in children was common. The majority of cases were caused by Lyme borreliosis, and nearly all of these were associated with lymphocytic meningitis.     

Hospital Admissions for Wheezing and Asthma in Childhood—Are They Avoidable?

Hospital admission rates for asthma and wheezing are still high, especially in younger children. We performed a prospective study of children admitted for asthma or wheezing to Stavanger University Hospital during one year. Prehospital emergency treatment, prophylactic asthma treatment, and possible risk factors for hospital admission were registered. A total of 337 admissions for 288 children were included. Recommended inhaled emergency treatment was administered prior to only 33% of the admissions. Inhaled steroids had been prescribed before 43% of admissions for asthma, and symptomatic treatment with a β2-agonist prior to 74% of admissions. Parental smoking was frequent. There seems to be a high potential to prevent admissions for asthma and wheezing by improving prophylactic asthma care and prehospital emergency treatment, as well as avoiding parental smoking. An increased focus should be on education and implementation of guidelines.     

Lung function and bronchial hyper-reactivity from 11 to 18 years in children with bronchiolitis in infancy

Background

Various trajectories for lung function and bronchial hyper-reactivity (BHR) from early childhood to adulthood are described, including puberty as a period with excessive lung growth. Bronchiolitis in infancy may be associated with increased risk of developing chronic obstructive pulmonary disease, but the development of respiratory patterns during puberty is poorly characterized for these children. We aimed to study the development and trajectories of lung function and BHR from 11 to 18 years of age in children hospitalized for bronchiolitis in infancy.

Methods

Infants hospitalized for bronchiolitis at the University Hospitals in Stavanger and Bergen, Norway, during 1997-1998, and an age-matched control group, were included in a longitudinal follow-up study and examined at 11 and 18 years of age with spirometry and methacholine provocation test (MPT). The MPT data were managed as dose-response slope (DRS) in the statistical analyses. Changes in lung function and DRS from 11 to 18 years of age were analyzed by generalized estimating equations, including interaction terms.

Results

z-scores for forced vital capacity (FVC), forced expiratory volume in first second (FEV₁), FEV₁/FVC ratio, and DRS were not different from 11 to 18 years of age in both the post-bronchiolitis and the control group. The trajectories from 11 to 18 years did not differ between the two groups. BHR at age 11 was independently associated with asthma at age 18.

Conclusion

Children hospitalized for bronchiolitis had stable predicted lung function and BHR from 11 to 18 years of age. The lung function trajectories were not different from controls.

     

Juvenile myasthenia gravis in Norway: A nationwide epidemiological study

Background

The aim of this study was to assess the incidence rate and prevalence of autoimmune myasthenia gravis (MG) among children in Norway.

Comparison of the efficacy and safety of live attenuated cold-adapted influenza vaccine, trivalent, with trivalent inactivated influenza virus vaccine in children and adolescents with asthma

BACKGROUND: Despite their potential for increased morbidity, 75% to 90% of asthmatic children do not receive influenza vaccination. Live attenuated influenza vaccine (LAIV), a cold-adapted, temperature-sensitive, trivalent influenza vaccine, is approved for prevention of influenza in healthy children 5 to 19 years of age. LAIV has been studied in only a small number of children with asthma. METHODS: Children 6 to 17 years of age, with a clinical diagnosis of asthma, received a single dose of either intranasal CAIV-T (an investigational refrigerator-stable formulation of LAIV; n = 1114) or injectable trivalent inactivated influenza vaccine (TIV; n = 1115) in this randomized, open-label study during the 2002-2003 influenza season. Participants were followed up for culture-confirmed influenza illness, respiratory outcome, and safety. RESULTS: The incidence of community-acquired culture-confirmed influenza illness was 4.1% (CAIV-T) versus 6.2% (TIV), demonstrating a significantly greater relative efficacy of CAIV-T versus TIV of 34.7% (90% confidence interval [CI] 9.4%-53.2%; 95% CI = 3.9%-56.0%). There were no significant differences between treatment groups in the incidence of asthma exacerbations, mean peak expiratory flow rate findings, asthma symptom scores, or nighttime awakening scores. The incidence of runny nose/nasal congestion was higher for CAIV-T (66.2%) than TIV (52.5%) recipients. Approximately 70% of TIV recipients reported injection site reactions. CONCLUSIONS: CAIV-T was well tolerated in children and adolescents with asthma. There was no evidence of a significant increase in adverse pulmonary outcomes for CAIV-T compared with TIV. CAIV-T had a significantly greater relative efficacy of 35% compared with TIV in this high-risk population.     

Urinary eosinophil protein X in children with asthma: Influence of atopy and airway infections

It has been suggested that urinary eosinophil protein X (U‐EPX) can be used to monitor bronchial inflammation in childhood asthma. However, the influence of atopy and airway infections is not well elucidated. To determine the clinical value of measuring U‐EPX in children with asthma and to evaluate the influence of atopy and airway infections, U‐EPX was measured in 170 children with asthma (mean age 69 months, range 12–179 months), in 79 children with lower or upper respiratory tract infections (mean age 41 months, range 1–165 months), and in 64 controls. U‐EPX was elevated in children with acute asthma (median 132 µg/mmol of creatinine, quartiles 77–195 µg/mmol of creatinine, n = 51, p < 0.001) and chronic asthma (median 93 µg/mmol of creatinine; quartiles 46–149 µg/mmol of creatinine, n = 119, p < 0.01) compared with controls (median 54 µg/mmol of creatinine; quartiles 40–89 µg/mmol of creatinine, n = 39). Atopic children had higher levels of U‐EPX than non‐atopics with acute asthma (median 155 µg/mmol of creatinine, quartiles 113–253 µg/mmol of creatinine, n = 27, vs. median 102 µg/mmol of creatinine, quartiles 56–168 µg/mmol of creatinine, n = 24, p < 0.05), as well as with chronic asthma (median 110 µg/mmol of creatinine, quartiles 65–162 µg/mmol of creatinine, n = 63, vs. median 60 µg/mmol of creatinine, quartiles 39–123 µg/mmol of creatinine, n = 56, p < 0.01). In chronic asthma, children without atopy had levels of U‐EPX similar to values of controls; levels were similar in symptomatic and asymptomatic patients, and not influenced by treatment with inhaled corticosteroids. Moreover, U‐EPX levels were higher in children with pneumonia (median 207 µg/mmol of creatinine, quartiles 111–280 µg/mmol of creatinine, n = 35, p < 0.001), laryngitis (median 109 µg/mmol of creatinine, quartiles 65–161 µg/mmol of creatinine, n = 24, p < 0.01), and rhinitis (median 172 µg/mmol of creatinine, quartiles 123–254 µg/mmol of creatinine, n = 19, p < 0.001) than in controls (median 62 µg/mmol of creatinine, quartiles 41–93 µg/mmol of creatinine, n = 64). There was significant overlap among all groups of children with disease, as well as between children with disease and controls. Hence, U‐EPX may reflect differences in eosinophil involvement and activation between children with atopic and non‐atopic asthma, but the individual spread within groups and the influence of airway infections limits the clinical value of U‐EPX in childhood asthma.     

Hospital Admissions for Wheezing and Asthma in Childhood—Are They Avoidable?

Hospital admission rates for asthma and wheezing are still high, especially in younger children. We performed a prospective study of children admitted for asthma or wheezing to Stavanger University Hospital during one year. Prehospital emergency treatment, prophylactic asthma treatment, and possible risk factors for hospital admission were registered. A total of 337 admissions for 288 children were included. Recommended inhaled emergency treatment was administered prior to only 33% of the admissions. Inhaled steroids had been prescribed before 43% of admissions for asthma, and symptomatic treatment with a β2-agonist prior to 74% of admissions. Parental smoking was frequent. There seems to be a high potential to prevent admissions for asthma and wheezing by improving prophylactic asthma care and prehospital emergency treatment, as well as avoiding parental smoking. An increased focus should be on education and implementation of guidelines.